Volunteer Form

Abide Volunteer

Phone

This field is for validation purposes and should be left unchanged.

Thank you for your interest in volunteering for the Free Dental Clinic on May 17, 2026 in Poulsbo, WA!

Professional dental workers (dentists, hygienists, assistants, etc.) as well as general volunteers are needed to make the clinic a success as we hope to serve 100+ patients on clinic day. This will be an incredibly powerful experience for each patient, for the community, and for you!

Please fill out the form below to register to volunteer:

If you have any questions:

Please contact Sharla Erich at 707-684-9701 or sderich@yahoo.com.

1. Full Name*

First Last

2. Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

3. Phone Number (Please provide a number that we can send a text message to.)*

4. Email*

5. Emergency Contact: Name & Phone Number*

6. Professional area of Service*

Dentist

Hygienist

Dental Assistant

Opthalmologist / Optometrist

Doctor / Nurse Practitioner

Nurse / Nursing assistant

General Volunteer (Please skip to #7)

7. Please indicate the area(s) you would like to serve.

Set up / Take Down

Translation

Registration

Parking

Hospitality

*We ask that all practicing Medical Providers complete the volunteer and waiver form for Life and Health Network (The ministry that will be providing our equipment) at the link provided at the bottom of the page. This form is specific to our Poulsbo clinic.

Okay! I can do that.

Please upload your license here:

Max. file size: 150 MB.

8. If you checked "Translation," please list the language(s) you speak fluently.

9. T-Shirt Size (please choose one by April 30)*

10. Shift Availability*

Friday, May 15 – 12:00pm (Set up)

Sunday, May 17 – 6:30am – 3:30pm (clinic day)

Sunday, May 17- 3:30pm – 8:00pm (take down)

11. I am 18 years old or older

yes

no*

*if less than 18 years old, please tell us your age & parent/guardian's name and phone number:

12. We plan to provide breakfast, lunch, and dinner on clinic day. Please list any food allergies you may have:

13. Any questions or comments?

14. Please read the below volunteer waiver information form below

This Release and Waiver of Liability (the “release”) executed on below-written date by __________________ (“Volunteer”) releases ABIDE free health clinics and Poulsbo Seventh-day Adventist Church (“Nonprofit”), a nonprofit corporation organized and existing under the laws of the State of Washington and each of its directors, officers, employees, and agents. The Volunteer desires to provide volunteer services for Nonprofit and engage in activities related to serving as a volunteer. Volunteer understands that the scope of Volunteer’s relationship with Nonprofit is limited to a volunteer position and that no compensation is expected in return for services provided by Volunteer; and that Volunteer is responsible for their own insurance coverage in the event of personal injury or illness as a result of Volunteer’s services to Nonprofit. 1. Waiver and Release: I, the Volunteer, release and forever discharge and hold harmless Nonprofit and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the services I provide to Nonprofit. I understand and acknowledge that this Release discharges Nonprofit from any liability or claim that I may have against Nonprofit with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I provide to Nonprofit or occurring while I am providing volunteer services. 2. Insurance: Further I understand that Nonprofit does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health or disability benefits or insurance. I expressly waive any such claim for compensation or injury or medical expenses incurred by me. 3. Medical Treatment: I hereby Release and forever discharge Nonprofit from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency services I provide to Nonprofit may include activities that may be hazardous to me including, but not limited to _______________ involving inherently dangerous activities. As a volunteer, I hereby expressly assume risk of injury or harm from these activities and Release Nonprofit from all liability. 4. Photographic Release: I grant and convey to Nonprofit all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by Nonprofit in connection with my providing volunteer services to Nonprofit. 5. Other: As a volunteer, I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Washington and that this Release shall be governed by and interpreted in accordance with the laws of the State of Washington. I agree that in the event that any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected. By signing below, I express my understanding and intent to enter into this Release and Waiver of Liability willingly and voluntarily.

TYPING YOUR NAME BELOW WILL ACT LIKE A SIGNATURE, SIGNIFYING THAT YOU HAVE READ, UNDERSTAND, AND AGREE TO THE CONTENTS OF THE VOLUNTEER WAIVER FORM ABOVE*

First Last

Today's date:*

*for all dental and vision practitioners only, please fill out the life and health volunteer form specific to our clinic here:

life and health volunteer form for vision/dental practitioners

If you can’t volunteer, but would still like to help:

We are actively raising funds for the clinic. If you would like to contribute, you can make a tax-deductible donation here. Indicate your contribution on the line for “Abide Free Health Clinics.”